We’ve all been sick from time to time. Usually it’s not more than an inconvenience, but it’s never pleasant. Even a mild cold gives you a runny nose that becomes a little more sensitive with every tissue that you use. Being sick can affect our moods too because it's upsetting to feel bad. However, what if the sickness lingers? What if it will be with us for months, years, or potentially throughout our lives? Chronic illnesses*** are ones that last a very long time, and sometimes they can’t be fully cured. It probably shouldn’t be surprising that ⅓ of all people with chronic illnesses will also have a diagnosis of depression. For those with chronic pain, **35%-45% will have depression.

When we’re talking about chronic illnesses*, we’re talking about things like:

Alzheimer's disease
Autoimmune diseases
Cancer
Heart disease
Diabetes
Epilepsy
HIV/AIDS
Hypothyroidism
Multiple sclerosis
Parkinson's disease
Stroke

For those that are diagnosed with a life-changing illness or condition, previously enjoyed* activities may lose their appeal, or in some cases, may prove difficult or impossible. It can be especially difficult for children diagnosed with a chronic illness. Growing up is hard under the best of circumstances. Adding a chronic illness can affect all parts of their development, and it can create difficulty for the entire family. This stress puts these kids at a much higher risk for mental illnesses, especially depression.

This sounds bad enough, right? The problems actually become more complicated* from here because just as deteriorating physical health can negatively impact one’s mental health, mental health conditions have a negative impact on physical health. Depression*** can worsen pain and side effects that are already present with chronic physical illnesses. This becomes a vicious cycle that gets worse over time. Which is why it is important to treat both together.

Major warning signs of depression*** include:

An extended period of down mood and a loss of interest in previously enjoyed activities
Changes in eating–much more or less than usual
Changes in sleeping–much more or less than usual
Difficulty concentrating
Reduced ability to feel emotions
Fatigue
Feelings of worthlessness or guilt
Frequent or persistent thoughts of suicide

Depression and many mental illnesses are typically treated through medication, talk therapy/counseling, or both together. For someone who has a chronic illness or condition, it is normal to have a hard time adjusting. Feeling sad is common because a person may have to grieve the loss of the way that parts of their lives have always been. When these sad feelings intensify and persist for more than a couple of weeks, it is possible that this persistent sadness is starting to turn into depression*. Depression is, however, treatable. As you work through treating your physical health, don’t neglect the importance of good mental health practices like:

Eating the right amounts of healthy foods
Getting enough quality sleep
Get sufficient movement and/or exercise
Mindfulness practice
Building up and practicing good coping skills
Counseling and medical treatment of mental health conditions

It is important to rally support behind you and be willing to ask for help if you find yourself dealing with a chronic condition. Learning to come to terms with and living with the changes that occur from a chronic condition make a real difference in one’s ability to cope. I remember advice that I heard a counselor tell a group of people who were struggling. This counselor was in a wheelchair after a car accident when he was a teen. He told the group that he had learned a long time ago that the list of things that people could do was massive. He could concentrate on the things that he was no longer able to do, but that just made him sad. He found it to be empowering to re-adjust his focus to the remaining, still massive, list of things that he could still do.

*https://nimh.nih.gov/health/publications/chronic-illness-mental-health

**https://www.psychiatry.org/News-room/APA-Blogs/Chronic-Pain-and-Mental-Health-Interconnected

***https://my.clevelandclinic.org/health/articles/9288-chronic-illness-and-depression

The third way to alleviate depression is through exercise. When many people think of exercise, they get images in their minds of gyms full of impressively fit people who can bench press small cars, and look sexy while they’re at it. Many people also have memories of getting gym memberships as a New Year’s resolution, and then they stopped going in February. It’s really no wonder why a lot of people find gyms to be intimidating or associated with feelings of failure and shame.

The thing about exercise is that it doesn’t have to fit a mold or even involve a gym. Don’t get me wrong, gyms are a good choice for a lot of people. They are full of expensive weight training and exercise equipment that the average person may not be able to afford. They often have exercise classes that are a fun way of working out with a group. They often have personal trainers that are knowledgeable and able to help a person on their fitness journey. They might even have an indoor pool. Gyms are great for many people, but they certainly aren’t for everyone.

Exercise increases our breathing and speeds up our heartbeat, which supplies more oxygen to our brains. Exercise is shown to improve sleep and decrease anxiety. Exercise also decreases depression symptoms. In fact, let's go back to the very beginning of this blog series. Remember when I said that I often hear people with depression tell me that they just don’t feel like doing anything? Over time, exercise has a positive effect on levels of dopamine and serotonin–important neurotransmitters in the brain that cause us to feel good and feel motivated. Exercise helps people with ADHD as well, and exercise has been linked with slowing cognitive decline with age. People who exercise are at a decreased risk of Alzheimer’s. Clearly, exercise is great for our brains.

Still, exercise is, for some, an intimidating word, so let's revamp the idea of exercise and just emphasize movement. Human bodies aren’t meant to sit all day. We are meant to move. I once read an article in a running magazine that said that the benefits of running vs. walking were virtually the same. The article said that the runner has a slight advantage in health benefits, but it isn’t much. What is the point of this? The important thing is just to move, not necessarily that you move fast.

What is the best form of exercise? That is like asking what is the best pizza topping. It depends on the person (though I maintain that pineapple has no business on a pizza). The best type of exercise is the one that you enjoy and are most likely to stick with. That could be weight training with free weights or machines, running, biking, swimming, zumba, yoga, cross fit, walking/hiking, body weight exercises, martial arts, or any of the other types of exercise that I’ve forgotten.

Maybe you don’t want to pay for a gym membership. That’s fine. Running, walking, and bike riding are free, so are pushups, pullups, wall sits, and burpees (we all hate burpees). There are a ton of free resources online, like yoga resources on YouTube–there is a channel called Yoga with Adriene that is especially good. Care should be taken when picking out online resources for exercise, and it is usually recommended that you check with your doctor before starting a specific workout regime.

Whatever exercise or combination of exercises that you pick, there will come a day that you don’t feel motivated to work out. This is normal, but the important thing is to do it anyway. Motivation isn’t an external force that taps us on the shoulder and reminds us to get out there and get to work. Before we can build motivation, we must build our discipline. The motivation to continue will show up once you have momentum. Make a commitment to yourself and your mental health and stick with it. Your mood and feelings will thank you.

As stated in the beginning, depression is a very serious mental health disorder. It isn’t simply feeling down or sad. It is complicated, and for some, it is brutal. True help with depression often requires professional assistance through medications and/or counseling, and there is no shame in asking for this help. Making an effort to improve sleep, diet, and exercise are key efforts that you can make to help yourself as well.